TY - JOUR
T1 - Prognostic significance of mitotic rate in localized primary cutaneous melanoma
T2 - An analysis of patients in the multi-institutional american joint committee on cancer melanoma staging database
AU - Thompson, John F.
AU - Soong, Seng Jaw
AU - Balch, Charles M.
AU - Gershenwald, Jeffrey E.
AU - Ding, Shouluan
AU - Coit, Daniel G.
AU - Flaherty, Keith T.
AU - Gimotty, Phyllis A.
AU - Johnson, Timothy
AU - Johnson, Marcella M.
AU - Leong, Stanley P.
AU - Ross, Merrick I.
AU - Byrd, David R.
AU - Cascinelli, Natale
AU - Cochran, Alistair J.
AU - Eggermont, Alexander M.
AU - McMasters, Kelly M.
AU - Mihm, Martin C.
AU - Morton, Donald L.
AU - Sondak, Vernon K.
PY - 2011/6/1
Y1 - 2011/6/1
N2 - Purpose: The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods: From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm2 to 48% for those with ≥ 20/mm2 (P < .001). Mean number of mitoses/mm2 increased as the primary melanomas became thicker (1.0 for melanomas ≤ 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had ≥ 5 mitoses/mm2 compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (χ2 = 104.9; P < .001), mitotic rate (χ2 = 67.0; P < .001), patient age (χ2 = 48.2; P < .001), ulceration (χ2 = 46.4; P < .001), anatomic site (χ2 = 34.6; P < .001), and patient sex (χ2 = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (χ2 = 3.2; P = .37). Conclusion: A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness.
AB - Purpose: The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods: From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm2 to 48% for those with ≥ 20/mm2 (P < .001). Mean number of mitoses/mm2 increased as the primary melanomas became thicker (1.0 for melanomas ≤ 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had ≥ 5 mitoses/mm2 compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (χ2 = 104.9; P < .001), mitotic rate (χ2 = 67.0; P < .001), patient age (χ2 = 48.2; P < .001), ulceration (χ2 = 46.4; P < .001), anatomic site (χ2 = 34.6; P < .001), and patient sex (χ2 = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (χ2 = 3.2; P = .37). Conclusion: A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness.
UR - https://www.scopus.com/pages/publications/79957929511
U2 - 10.1200/JCO.2010.31.5812
DO - 10.1200/JCO.2010.31.5812
M3 - Article
C2 - 21519009
AN - SCOPUS:79957929511
SN - 0732-183X
VL - 29
SP - 2199
EP - 2205
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 16
ER -